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DIT Phase II Chapters > Gastrointestinal > Flashcards

Flashcards in Gastrointestinal Deck (67):
1

Organism associated with Whipple disease

Organism associated with Whipple disease: Tropheryma whippelii (+); "Foamy Whipped cream in a CAN". Foamy (PAS-positive) macrophages; Cardiac symptoms; Arthralgias; Neurologic symptoms.

2

Process by which B12 is absorbed

  • (stomach) Pepsin releases B12
  • (stomach) B12 binds to R-binders
  • (duodenum) R-binder-B12 complex broken down in duodenum by pancreatic proteases 
  • (duodenum) unbound B12 binds IF 
  • IF-B12 complex binds to IF-specific receptors on cells of the Terminal Ileum
  • B12 transverses plasma membranes of mucosal cell 
  • picked up by plasma protein transcobalamin II

3

Pleomorphic adenoma

#1 most common overall is Pleomorphic adenoma - benign, epithelial and mesenchymal, about 50% of all salivary gland tumors are this type.

4

#2 most common benign tumor of salivary gland

 #2 most common benign tumor is Warthin's tumor - heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue.

5

#2 most common tumor overall salivary gland tumor

mucoepidermoid carcinoma -#1 malignant

6

$ 3 Arteries off celiac

Main blood supply of the stomach: common hepatic, splenic, left gastric 

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7

$ Primary biliary cirrhosis

Autoimmune reaction with lymphocyte infiltrate and granulomas. 90% are middle aged females, Pruritis w/o Jaundice.

  • 90% ↑ serum mitochondrial antibodies, including IgM.
  • Tx: Ursodiol ↓ liver synthesis of cholesterol ↓ bile stone development. Definitive Tx: liver transplant

8

$ Primary sclerosing cholangitis

Unknown cause of "onion skin" bile duct fibrosis with alternating strictures and dilation with "beading"

  • (1)Beads on a string appearance on ERCP.
  • (2) Men around 40.
  • (3) 60% have positive p-ANCA. Also an association with
  • (4) Ulcerative colitis, and
  • (5) Cholangiocarcinoma.
  • Definitive Tx: liver transplant

9

2 nervous tissue bundles that run through the GIT

Submucosal Nerve Plexus (Meissner's) running through the Submucosa (secretions).

Myenteric nerve plexus (Auerbach's) running through outer layer of the muscularis externa (Motility and MMCs).

10

4 off common hepatic

  • Right Gastro-omental artery,
  • Anterior superior pancreaticoduodenal arteries (supplies proximal duodenum),
  • Hepatic artery proper,
  • Right Gastric artery.

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11

Achalasia is a results from

loss of myenteric or Auerbach's plexus ® LES is unable to relax; Diagnosis - barium swallow (stricture of LES looks like bird's beak), manometry - device that measures pressure in esophagus.

12

Alcoholic hepatitis histologically

Mallory bodies - intracytoplasmic eosinophilic inclusions; Hepatocytes - Necrotic and swollen.

13

Antibodies to help make the diagnosis of autoimmune hepatitis

  • ANA (+)
  • Anti-smooth muscle antibody (+)
  • Anti-liver-kidney microsomal antibody (+)
  • Anti-mitochondrial antibody (-)

14

Arterial branches off the common hepatic artery

1. Gastroduodenal artery ® Right Gastro-omental artery + Superior pancreaticoduodenal artery;

2. Right gastric artery;

3. Hepatic artery proper ® Left hepatic and right hepatic.

15

Atropine will inhibit the release of gastrin b/

Atropine will inhibit the release of gastrin b/c: Vagus nerve stimulates G cells using gastrin-releasing peptide; Atropine - reduces vagal stimulation at parietal cells and ECL cells. Vagal stimulation of G cells is unaffected as GRP is used, not ACh.

16

Biliary obstruction Intrahepatic vs extrahepatic causes

Intrahepatic: Primary biliary cirrhosis; Sclerosing cholangitis; Drugs (Chlorpromazine and arsenic);

Extrahepatic: Pancreatic neoplasm; Choledocholithiasis (gallstone in common bile duct); pancreatitis; cholangiocarcinoma.

17

Budd-Chiari syndrome

Occlusion of the IVC or hepatic veins. Associated with Polycythemia vera; Pregnancy; Hepatocellular carcinoma. Hepatomegaly, ascites, abdominal pain, possible varices and visible abdominal and back veins, Absence of JVD. Eventual liver failure due to occlusion of IVC or hepatic veins with centrolobular congestion and necrosis.

18

 Cholangitis 


Cholecystitis


Choledocholithiasis 


Cholelithiasis 

  • Cholangitis - Inflammation/infection of biliary tree (Charcot's/Reynolds)
  • Cholecystitis - Inflammation/infection of the gallbladder
  • Choledocholithiasis - Gallstones in the bile ducts (usually common bile duct)
  • Cholelithiasis - Gallstones

19

Classic symptoms of carcinoid syndrome

"BFDR" Bronchospasm (wheezing); Flushing; Diarrhea (less specific); Right sided valvular disease symptoms (edema or ascites).

20

Classic triad in hemochromatosis

micronodular cirrhosis, DM, skin pigmentation. Labs - ↑ ferritin, ↑ serum iron, ↓ TIBC -> ↑ transferrin saturation. Tx: Phlebotomy; Deferoxamine.

21

Cocktail of medications commonly taken by patients suffering from severe cirrhosis

Lactulose (encephalopathy); Vitamin K (maximize clotting potential); Diuretics (prevent ascites and edema); β-blockers (bleeding esophageal varices) "LV DB" needs meds for liver cirrhosis"

22

Colon Polyps

Tubular adenomas (adenomatous polyps); Tubular villous adenomas; Villous adenomas. All are precancerous, but villous is most villainous! All 3 of these NEED to be removed 100% of the time! Need to be analyzed for carcinoma in-situ.

23

Common causes of SBO

 #1 - Adhesions, Bulge/hernia, Cancer/tumor. 

24

Difference between primary biliary cirrhosis and primary sclerosing cholangitis

 Primary Biliary Cirrhosis: Positive AMA; Middle-aged females; Autoimmune disease - CREST scleroderma. 

 

Primary Sclerosing Cholangitis: Unknown etiology; Positive pANCA; Males over 40; UC and cholangiocarcinoma; ERCP: beading and stricturing

25

Disorders w/ excess gastrin

Zollinger Ellison syndrome; Tx is PPIs +/- octreotide (if tumor has octreotide receptors). 

26

Drugs that inhibit acetylcholinesterase

Echothiophate - glaucoma;

Edrophonium - diagnose MG;

Neostigmine - ileus, urine retention, MG;

Physostigmine - glaucoma;

Pyridostigmine (longer acting) - MG.

27

Enzyme responsible for the conjugation of bilirubin

 

Fate of bilirubin after it is conjugated and secreted into GI tract

UDP-Glucuronyl Transferase. (upregulated by phenobarbital)

 

(1) Converted to urobilinogen (acted on by gut bacteria) (2) Some is excreted and (3) some is reabsorbed.

28

GI pathology with Down Syndrome

Celiac disease; Hirschprung disease; Annular pancreas; Duodenal atresia. (CHAD)

29

Hexokinase and glucokinase differ in Location, Kinetics, Insulin

Hexokinase is everywhere ↓Vmax ↓Km and Glucokinase is in liver and Pancreas (β cells) with ↑Vmax ↑Km. Insulin does NOT induce hexokinase, Does induce glucokinase.

30

HIV meds pancreatitis

Ritonavir and NRTIs like Didanosine, Stavudine, Zalcitabine;

Rash - NNRTIs like Nevirapine, Delavirdine, Efavirenz and Abacavir causes a hypersensitivity. 

Peripheral neuropathy - Didanosine, Stavudine, Zalcitabine.

31

In a patient with elevated alkaline phosphatase, what  other enzymes would indicate liver disease?

an elevation in AST, ALT, GGT would direct me to a diagnosis of liver disease. 

32

Mechanism by which aspirin can cause Reye syndrome

↓ β-oxidation occurs because metabolites of aspirin inhibit mitochondrial enzyme.

33

Medications for the treatment of chronic hepatitis B and C are

 interferon alpha (Chronic hepatitis B and C); Ribavirin (chronic hepatitis C) 

34

Names of diverticula found in esophagus based on location are

Zenker - immediately above the UES;

Traction - Near the midpoint of esophagus;

Epiphrenic - immediately above LES. 

35

One of the most common causes of GI bleeding in the elderly (other than colon cancer)

 One of the most common causes of GI bleeding in the elderly (other than colon cancer) is  Angiodysplasia (volvulus, ischemic colitis also common in elderly)

36

Pleomorphic adenoma histology

(#1 benign). Histology: Epithelial and mesenchymal differentiation. 50% of salivary gland tumors are pleomorphic.

37

PPI MOA

 H+/K+ ATPase in stomach parietal cells: Omeprazole, lansoprazole, pantoprazole, esomeprazole.

38

Progastric Hormones

Inhibitory Gastric Acid Hormones

Drugs that regulate Gastric Acid Secretion

Progastric Hormones: Histamine; Acetylcholine; Gastrin.

Inhibitory Gastric Acid Hormones: Prostaglandins; Somatostatin; Secretin; GIP (gastric inhibitory peptide).

Drugs that regulate Gastric Acid Secretion: PPIs; H2 blockers; Antimuscarinic drugs (Atropine).

39

Receptors on gastric parietal cells regulate acid secretion

H2 Histamine receptor is most important; CCKB receptors (responds to gastrin); M3 (responds to Ach); Prostaglandin receptors; Somatostatin receptors.

40

Risk factors for development of hepatocellular carcinoma

HBV, HCV, Wilson's disease, hemochromatosis, α1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus), Hepatic adenoma.

41

Reynold's pentad 

cholangitis is: Jaundice, Fever, RUQ pain, Hypotension (shock) and altered mental status.

42

Risk factors for the development of cholesterol gallstones 

FFFF: Female, Fat, Fertile (pregnant), Forty.

43

Warthin's tumor

Second most common benign cystic tumor with a double layer of columnar epithelium around the cyst. Stroma of the tumor is lymphoid. Like a lymph node and can even form germinal centers

44

Serum antibodies associated with celiac sprue

Autoantibodies to gluten (gliadin) and tissue transglutaminase

45

Organisms most responsible for Sialodenitis

S. Aureus and S. Viridans, S. Mutans.

46

Signs of portal hypertension

Esophageal varices ® Hematemesis, Melena. Peptic ulcer ® Melena; Splenomegaly; Caput medusae, ascites; Portal hypertensive gastropathy; Hemorrhoids.

47

The most common #1 malignant salivary gland tumor (and #2 most common overall behind pleomorphic adenoma) 

 mucoepidermoid carcinoma

48

Treatment for celiac sprue

Gluten free diet; Avoid rye, wheat, and barley

49

Underlying problem in Wilson disease

Impaired copper excretion, Body does not put copper into bile-> failure of copper to enter circulation as ceruloplasmin.

Characteristics -> Asterixis; Basal ganglia degeneration (Parkinsonian symptoms); ↓ ceruloplasm; Cirrhosis; Kayser-Fleischer rings; Copper accumulation; Hepatocellular carcinoma; Dementia; Dyskinesia; Dysarthria Tx: Penicillamine

50

Classic presentation of diverticulosis

Usually asymptomatic; ± Painless rectal bleeding; ± Vague LLQ discomfort

51

After loss of his job, a 35-year-old man has diarrhea and hematochezia. Intestinal biopsy shows transmural inflammation. Diagnosis ® 35yo male + diarrhea + hematochezia + Stress (loss job) + TRANSMURAL INFLAMMATION 

Crohn's Disease

52

Adult Anatomy of the liver

Zone 1 - Hepatic artery(↑O2), hepatic vein, bile ductules affected most by viral hepatitis;

Zone 3 - Central vein (affected most by ischemia) Contain cytochrome p450 (most affected by alcoholic hepatitis).

53

Diverticulitis Tx

Metronidazole (for anaerobes)  + TMP-SMX, or M + levofloxacin, or M + ciprofloxacin.

54

Dysbiosis

imbalance of the enterobacteriaceae species

55

Enterobacteriaceae

All are Gram (-); facultative anaerobe; ferment sugar into lactic acid (if too much, can cause lactic acidosis). Normal gut flora. #1 Bacteroides fragilis - Most abundant organism in the large intestine. #2 E. coli - second most abundant organism in the large intestine. Family also includes: Proteus mirabilis; Proteus vulgaris; Salmonella; Shigella; Klebsiella pneumoniae.

56

Etiologies of acute pancreatitis

GET SMASHHED - Gallstones, Ethanol, Trauma (NFL), Steroids, Mumps, Autoimmune diseases, Scorpion sting, Hypercalcemia/Hypertriglyceridemia >1000 (milk/tricycle at HH), ERCP (Endoscopic retrograde cholangiopancreatogram), Drugs (sulfa + HIV drugs) (NRTI's didanosine, zalcitabine, stavudine, Ritonavir (PI).

57

Fundamental problem in Hirschprung disease

failure of neural crest cell migration to colon ® missing enteric ganglia/enteric nervous plexus.

58

H. pylori treatment

PPI; Clarithromycin; Amoxicillin or (if allergic to amoxicillin) metronidazole.

59

HBcAg

Hepatitis B core antigen = New disease

60

HBeAg

Hepatitis B envelope antigen - very High degree of contagiousness 

61

HBsAg

hepatitis B surface antigen = Active disease!

62

Intestinal disorder common in NICU to premature babies that receive oral feds too soon

Necrotizing Enterocolitis

63

Lab abnormalities with cirrhosis

↑AST/ALT but may not if damaged all of liver cells. ↑GTT ↓platelets  ↑PT; ↓lipids (LDL, HDL); ↑ammonia

64

Metoclopramide (Reglan)

antagonist at the D2-receptor and agonist at 5-HT4 receptors. Used for diabetic and post-surgical gastroparesis (slight degree of gastroparalysis).

65

Ondansetron and Granisetron

(-setron) are the 5-HT3 antagonists used for anti-emetic purposes. 5-HT1 agonists cause vasoconstriction used to treat headaches. Serotonin antagonists cause vasodilation which create headaches. Too much serotonin (carcinoid syndrome) - diarrhea; Too little serotonin - constipation.

66

Osler-Weber-Rendu Syndrome

AD disorder; Telangiectasias can cause Aneurysms, AVMs - high output heart failure; Nose bleeds, GI bleeds, Iron deficiency anemia, Visceral bleeds (lung, liver).

67

 most common location of salivary gland tumors

Parotid gland